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Doctor discussing stages of lung cancer with patient

Lung cancer staging is used to describe the amount and extent of cancer in a patient’s body. This information helps physicians create an appropriate treatment plan and plays a role in determining a patient’s prognosis.

TNM staging for lung cancer

The most commonly used staging system for lung cancer is the TNM system from the American Joint Committee on Cancer (AJCC). It considers three key factors:

  • Tumor (T) – The size of the tumor and whether or not it has invaded nearby tissues
  • Lymph nodes (N) – Whether or not cancer has traveled to nearby lymph nodes
  • Metastasis (M) – If and how far the cancer has spread (metastasized) to other structures in the body, such as the other lung, brain or liver

Based on this information, a patient’s lung cancer is staged from 0 to 4, with 4 being the most advanced.

Stages of non-small cell lung cancer

The stage of non-small cell lung cancer (the most common type of lung cancer) is determined at the time of diagnosis by reviewing a patient’s imaging scans. Physicians look at the images to see how large the tumor is and whether it has spread to surrounding structures in the lungs. If a biopsy was performed, the results will be considered as well. Following the TNM system guidelines, a physician will assign one of five non-small cell lung cancer stages, ranging from 0 (the least advanced) to 4 (the most advanced).

Stage 0 lung cancer

These cancers are referred to as “in situ,” meaning “in place.” The tumors have not grown into nearby tissues, and there are no signs of cancer outside the lung.

Stage 1 lung cancer

These tumors are small (less than 5 centimeters wide) and have not spread to any nearby lymph nodes. In most cases, stage 1 lung cancer doesn’t produce any noticeable symptoms. As such, when lung cancer is diagnosed at this early stage, it’s typically because it was caught during a routine screening, and not because the patient had any complaints. When stage 1 lung cancer symptoms do appear, they may include:

  • Coughing (including a new and persistent cough, a chronic cough that worsens over time or a cough that produces bloody phlegm)
  • Shortness of breath
  • Persistent chest pain
  • Frequent lung infections (for example, bronchitis or pneumonia)

Stage 1 lung cancer treatment often includes a combination of surgery, targeted therapy, immunotherapy, chemotherapy and/or radiation therapy. The stage 1 lung cancer survival rate is relatively high—according to the American Cancer Society (ACS), the five-year relative survival rate for localized non-small cell lung cancer (cancer that hasn’t spread outside the lung) is 64%.

Stage 2 lung cancer

These tumors are still small (less than 7 centimeters wide) but have started to spread to local lymph nodes or other nearby structures. Like stage 1 lung cancer, stage 2 lung cancer typically doesn’t cause any noticeable symptoms. With that being said, when they do appear, stage 2 lung cancer symptoms may include:

  • A cough that is new and persistent, one that worsens over time or one that produces bloody mucus
  • Shortness of breath
  • Chronic chest pain
  • Regular lung infections

Also similar to stage 1 lung cancer, stage 2 lung cancer treatment generally consists of a combination of surgery, targeted therapy, immunotherapy, chemotherapy and/or radiation therapy. Per the ACS, the five-year relative survival rate for regional non-small cell lung cancer (cancer that’s spread outside the lung to nearby structures or lymph nodes) is 37%.

Stage 3 lung cancer

These cancers have spread to the lymph nodes in the center of the chest or other structures outside the lung. By the time lung cancer reaches stage 3, it’s more likely to produce noticeable symptoms. Some of the most common stage 3 lung cancer symptoms include:

  • A cough that persists, worsens over time or produces bloody phlegm
  • Shortness of breath
  • Chest pain
  • Hoarseness
  • Wheezing
  • Fatigue
  • Weakness
  • Reduced appetite
  • Unexplained weight loss
  • Repeated occurrences of lung infections

As with stages 1 and 2, stage 3 lung cancer treatment often involves a combination of surgery, targeted therapy, immunotherapy, chemotherapy and/or radiation therapy. According to the ACS, the five-year relative survival rate is 37% so long as the cancer has spread outside the lung to nearby structures or lymph nodes (regional non-small cell lung cancer), but not to distant areas of the body.

Stage 4 lung cancer

These cancers have spread to more than one area in the other lung, the fluid surrounding the lung or additional organs elsewhere in the body. Stage 4 lung cancer symptoms may include:

  • A persistent or worsening cough
  • Coughing or spitting up blood
  • Shortness of breath
  • Chest pain (this may worsen when inhaling deeply, coughing or laughing)
  • Hoarseness
  • Wheezing
  • Fatigue
  • Weakness
  • Loss of appetite
  • Unexplained weight loss
  • Frequent lung infections

Depending on where the lung cancer has spread (metastasized), it may also cause symptoms in those distant areas of the body. For example, if stage 4 lung cancer has spread to the liver, it may cause jaundice (yellowing of the skin and eyes). Or, if it’s spread to the brain, it might cause headaches, dizziness, balance problems, seizures or numbness in the extremities.

Stage 4 lung cancer treatment may involve a combination of surgery, targeted therapy, immunotherapy, chemotherapy and/or radiation therapy. However, in especially severe cases of stage 4 lung cancer, treatment often focuses on extending the patient’s life for as long as possible and improving their quality of life by relieving any resulting symptoms. Per the ACS, the five-year relative survival rate for distant non-small cell lung cancer (cancer that’s spread to distant areas of the body) is 8%.

Stages of small cell lung cancer

Small cell lung cancer—which accounts for about 15% of lung cancer cases—is also staged according to the TNM system. However, an additional staging system that labels the cancer as either limited stage or extensive stage is often used for treatment purposes.

  • Limited stage – This refers to small cell lung cancer that is confined to one side of the chest, including cancer that that has not spread beyond the lung or has traveled to lymph nodes on the same side of the chest.
  • Extensive stage – Most people with small cell lung cancer are diagnosed with extensive stage disease, which means cancer has spread beyond the lung and to other structures in the body, which may include the fluid surrounding the lung.

Treatment for lung cancer at Moffitt Cancer Center

Lung cancer stages help a physician determine which therapies might be most helpful for their patients. However, stages don’t take into account the fact that every patient responds differently to treatment and that an assigned cancer stage isn’t necessarily a predictor of a patient’s prognosis. Nobody understands this reality better than the multispecialty team in Moffitt Cancer Center’s Thoracic Oncology Program, where every patient receives an individualized treatment plan—regardless of the stage of their cancer. While our lung cancer specialists use evidence-based best practices to make their recommendations, we see our patients as much more than statistics, and we provide them with the tailored care they deserve.

Contact Moffitt to receive more information about lung cancer stages from our expert team of oncologists. Call 1-888-663-3488  or complete a new patient registration form online. No referral is needed, and we will be sure to connect you to a cancer expert as soon as possible.

References

American Cancer Society: Lung Cancer Survival Rates
American Cancer Society: Non-Small Cell Lung Cancer Stages
American Lung Association: Lung Cancer Staging